Mod2: Cardiac Physiology Flashcards
ACTION POTENTIALS
An abrupt pulse-like change or impulse in the membrane potential that is propagated (goes out all ways to all tissues) is known as:
An action potential
ACTION POTENTIALS
Which factors could elicit an An action potential (AP)?
Electrical, Mechanical, or Chemical factors that suddenly increases the permeability of the membrane to Na ions
Flicking the heart or giving epinephrine can cause an AP
ACTION POTENTIALS
An action potential results from the rapid change in membrane permeability to which ions?
Na+, K+, Ca2+, and Cl-
ACTION POTENTIALS
What are the three phases of an action potential?
The RMP
Depolarization
Repolarization

ACTION POTENTIALS
At which voltage is the Resting Membrane Potential (RMP) said to be polarized?
at -90mv

ACTION POTENTIALS
Which processes are reponsible for maintaining the RMP at -90 mV?
Primarily Diffusion and
Sodium potassium pump through active transport
- The membrane is said to be “polarized” as a large negative membrane is present (-90 mV)*
- RMP is 100x more permeable to K*

ACTION POTENTIALS
What’s another name for what occurs when a stimulus causes the membrane to become more permeable to sodium?
Depolarization
Na enters the cell and causes the potential to increase to -60 mV
A stimulus causes the membrane to become more permeable to Na and the potential begins to increase to threshold ( roughly -60 but references say different numbers)

ACTION POTENTIALS
T/F: Threshold is an “all-or-nothing” phenomenom that causes an action potential
True
If Threshold is not reached, the action potential will not happen
Picture shows two stimuli attempted to initiate AP but failed to reach threshold

ACTION POTENTIALS
What happens once the membrane reaches threshold?
Once threshold is reached, an action potential ensues and the Sodium channels open allowing for Na to come into the cell (depolarization)
More sodium channels open until membrane potential is +35 mV

ACTION POTENTIALS
What happens during repolarization?
Na permeability stops at about +35
Membrane becomes permeable to K+, which rushes out
This causes a decreased permeability to Na
Membrane potential return back to -90mV (RMP)
Repolarization has occured

ACTION POTENTIALS
What are the two types of action potentials?
Fast Action potentials
Slow actions potentials
ACTION POTENTIALS
Which Action Potentials are mediated by the opening of a large number of Na channels?
Fast Action potentials
ACTION POTENTIALS
Why are Fast Action potentials termed “open”?
Because they remain open for only a few thousandths of a second and then abruptly close
At the end of the closure, repolarization occurs and the AP is over until another one comes
If threshold is not reached, another action potential will not occur
Must be stimulated by an action potential to depolarize
Mediated by Na
ACTION POTENTIALS
Where do Fast Action potentials occur?
Located in atria, ventricles, and purkinje system
ACTION POTENTIALS
Which action potentials are are slower to open and close, can spontaneously depolarize
Slow Response Action Potentials
ACTION POTENTIALS
Where do Slow actions potentials occur?
Pacemaker cells SA node ( norm) & AV node
Under abnormal circumstances, the bundle of His, purkinje system, or cardiac muscle can take over
ACTION POTENTIALS
T/F: Slow Action Potentials Do not have a true RMP, whereas Fast Action Potentials do.
True
FAST RESPONSE ACTION POTENTIAL(SODIUM MEDIATED)
Describe Phase 0 of the Fast Response or Sodium Mediated Action Potential:
Phase 0: Rapid depolarization (Na in)
Corresponds to QRS
Occurs because Na permeability increases 100 fold
RMP increases from -90 to about -40 to -65 (depending on resource use) where threshold is reached
Once threshold is reached, AP ensues, and a second channel opens, which is calcium
At the onset of the action potential, K= permeability decreases 5 fold, delaying repolarization
Another AP cannot come in and cause depolarization until Repolarization occurs

FAST RESPONSE ACTION POTENTIAL(SODIUM MEDIATED)
Describe Phase 1 of the Fast Response or Sodium Mediated Action Potential:
Phase 1: Overshoot
This is the tip of the peak in which the cell membrane remains relatively impermeable to K
Inactivated H gates close and stop the influx of sodium

FAST RESPONSE ACTION POTENTIAL(SODIUM MEDIATED)
Describe Phase 2 of the Fast Response or Sodium Mediated Action Potential:
Phase 2: Plateau phase
Corresponds to the Q-T interval
There are three causes to the Plateau phase

FAST RESPONSE ACTION POTENTIAL(SODIUM MEDIATED)
What are the three causes to the Plateau phase (Phase 2)?
- Calcium channels are open fully (sodium and calcium are entering)
- Delayed closure of some of the sodium channels
- Permeability of potassium decreases even more (another 5-fold)

FAST RESPONSE ACTION POTENTIAL(SODIUM MEDIATED)
Describe Phase 3 of the Fast Response or Sodium Mediated Action Potential:
Phase 3 is Rapid repolarization
Corresponds to the T-wave on EKG
Permeability to NA and Ca stops, and the cell is permeability to potassium
There is a brief relative refractory period until Fully repolarized
Fully repolarized = down stroke of T-wave

FAST RESPONSE ACTION POTENTIAL(SODIUM MEDIATED)
Describe Phase 4 of the Fast Response or Sodium Mediated Action Potential:
Phase 4: Resting membrane potential (RMP)
Corresponds to the P-R interval
Maintained by the Na-K pump
Remains at -90 mV until a stimulus comes

SLOW RESPONSE ACTION POTENTIALS (CALCIUM MEDIATED)
Which ions primarily mediated the slow action potentials?
Calcium
SLOW RESPONSE ACTION POTENTIALS (CALCIUM MEDIATED)
The slow action potentials are primarily mediated by calcium, but why are they also called calcium-sodium channels?
Because they allow the influx of sodium when they open
SLOW RESPONSE ACTION POTENTIALS (CALCIUM MEDIATED)
What is Phase 0-2? How is it achieved?
Phase 0-2 is Depolarization
It is achieved primarily by the influx of calcium through the slow channels
Allows Na+ to come in with it
- AP develops more slowly and only reaches 0mV (as opposed to +35)*
- Starts less negative (-65) so threshold is achieve easier*

SLOW RESPONSE ACTION POTENTIALS (CALCIUM MEDIATED)
Describe Phase 3
Phase 3 is still repolarization
Still due to K+ exiting the cell

SLOW RESPONSE ACTION POTENTIALS (CALCIUM MEDIATED)
Describe Phase 4
Phase 4: is resting membrane potential
Corresponds to the P-R interval
The membrane is not steady, but rather increases (becomes less polarized/negative)
It increases slowly towards threshold due to a steady decline of the amount of potassium coming out of cell
Na and calcium begins to leak in. And once it reaches threshold, an action potential ensues even without a stimulus
This is known as Spontaneous Deopalarization and account for Automaticity
- RMP starts at only -50 to -65 as opposed to -90*
- Rate of spontaneous depolarization decreases as you descend from SA node (80-100) to the AV node (40-60)*

SLOW vs FAST ACTION POTENTIALS
What’s the Biggest difference between slow and fast APs?
Phase 4
In the Fast AP, the RMP stays steady d/t the Na+/K+ pump
In the Slow AP, it spontaneously depolarizes
Also, Slow channels do not have a plateau, and the slow AP starts closer to -65mV, so it gets up the threshold as lot easier than the fast AP which starts at -90mV
REFRACTORY PERIODS
What are the two types of
Absolute
Relative
REFRACTORY PERIODS
The timeframe where a stronger than normal stimulus cannot cause another AP in an excitable cell while it is depolarized is known as:
An absolute refractory
Shortly after the AP is initiated, the Na channels are inactivated until the membrane returns to the RMP
Na channels remain inactivated until RMP is reached
While the sodium gate is closed, a 2nd stimulus cannot cause depolarization

REFRACTORY PERIODS
The timeframe where a stronger than normal stimulus can cause depolarization as that potential reaches back down to RMP is known as:
The relative refractory phase
As the potential returns closer to baseline, a stronger than normal stimulus can cause depolarization.
Causes R on T phenomena

TRANSLATE INTO PRACTICE
How does hypokalemia affect RMP?
The lower potassium levels cause hyperpolarization (makes it more negative) of the RMP
Hypokalemia lowers RMP away from threshold
A greater than normal stimulus must come to push the RMP back to threshold so an AP can occur

TRANSLATE INTO PRACTICE
How does hyperkalemia affect RMP?
Hyperkalemia raises the RMP (normally -90mV) closer to threshold
Cells fire more easily hence the reason hyperkalemia causes arrhythmias
When resting potential reaches threshold, Na+ gates open and won’t close
For instance normally, the RMP is -90 and threshold is -65, the difference between the two would be 25
In the presence of hyperkalemia if the RMP increases to -70, the difference between the two becomes 15
A less strong stimulus can come in to cause depolarization

TRANSLATE INTO PRACTICE
Although calcium has not effect on extracellular K+, why is it often time used as the first line “treatment” for hyperkalemia?
Calcium restores the threshold, shifting it towards a more positive value thus farther away from the RMP that has been reset by the hyperkalemia
So the myocyte excitability can return to normal
